An interesting thing happened to me a few months ago on a Sunday morning. I was doing my after church thing…which means my children run around the sanctuary like banshees and pastor Jason is talking to a hundred or so folks and no one can decide what to do for lunch. It’s a routine of madness. In the midst of all of that I was approached by a family in our church. These are people I adore. They are faithful, they are helpful, they are fun. Their oldest has started that tortuous time we call middle school. As a side note there are literally 10 million things I would do over again before middle school. Like medical school, the last 4 weeks of pregnancy in the Oklahoma heat, 24 weeks of Gyn Oncology service as a resident….middle school seems like the worst thing….but back to the story.
This lovely family had visited their local pediatrician for a routine well child check. Their pediatrician had appropriately recommend the meningococcal vaccine and the Tdap vaccine (which they happily accepted) and then something strange happened….their pediatrician then asked them to “consider the HPV vaccine…to ask their friends, to read about it, to think and let the doc know what they wanted to do.” So they came to me to find out “why wouldn’t our doctor want our daughter to have this vaccine? Is there something wrong with it? What should we do?” At this point I am making that face when you are horrified by something…the one with your eyes wide and your mouth open. And of course I said yes..yes..yes…please go back and get the HPV vaccine series for your child!
If you didn’t know, Human Papillomavirus (HPV) is responsible for about 17,000 cancers a year in women and about 9,000 cancer per year in men. About half of men and women in the US will be infected with HPV at some point in their life…around 79 million Americans. Most of those infections occur between ages 19-24 and most of those young men and women will clear the infection on their own without a problem. So, you might ask, why do we vaccinate against HPV? Well, we know that almost 13,000 women in the US will be diagnosed with cervical cancer, and 99% or more of cervical cancer is caused by one of the high risk strains of HPV. 4,000 of those women will die of their disease. Additionally, more than 200 million health care dollars will be spent in 1 year in the US to treat other HPV related diseases such as genital warts. When you take into account all the screening for HPV related cancer and treatment of pre-cancerous HPV diseases the cost adds up to about 8 billion dollars. That’s billion, with a B. Imagine what our health care system could do with those dollars if we would significantly decrease or eliminate the burden of HPV disease through vaccination.
The vaccine works. Multiple studies have shown it to be extremely effective. We’re talking 99% effective against the pre-cancerous changes that I see and treat on a weekly basis to try and prevent my patients from getting cervical cancer. Right now about 39% of US adolescents are being vaccinated. The goal is for 80% of those eligible to receive the full vaccine series. In short, we are doing a terrible job folks. In contrast, our friends in Australia have a vaccination rate around 75%. They have virtually eliminated genital warts in those women under the age of 21 and soon will see a dramatic reduction in cervical cancer.
So why wouldn’t all our girls and boys age 11-12 receive the 3 dose HPV vaccine series? Well, first of all, our health care providers aren’t recommending the vaccine. My friends from church have great trust in their pediatrician and have faithfully received all the vaccinations recommended to them. But the HPV vaccine was not. If we as health care providers would recommend HPV vaccination along with other routine immunizations for 11 and 12 year olds we could exceed the 80% immunization goal. What are the barriers to provider recommendation? Well, there could be several.
Our culture has made the HPV vaccination into a moral argument. Parents believe that their child is more likely to become sexually active if vaccinated. This has been proved incorrect in the medical literature over and over and over again. Kids are no more likely to become sexually active after HPV immunization than they are to go seeking out someone to snuggle up with who has meningitis after being immunized against it at the same age. We assume that people infected with HPV and those who have HPV related diseases must have done something wrong, behaved inappropriately, had “loose morals” or some other kind of disgusting label such as that. The reality is that this disease can affect anyone. Show me someone whose life turned out exactly as they had planned and whose children turned out exactly as they had planned and maybe you have an argument against vaccination…maybe. But really for all of us, we don’t know what life will bring. We can’t predict much of what will happen to us or those around us. As I like to tell the medical students…no one leaves on a plane for Africa to do some good missionary work with the intention of finding someone with yellow fever and being infected…but we still get immunized before the trip without question. Immunization against HPV is just the same.
Additionally, our culture loves to believe what we read on the internet (ironically what you are doing right now). Despite this vaccine being shown by research in the US and multiple studies in Europe to be safe and demonstrate no pattern of serious neurologic or other injury, many in the US are still afraid that HPV immunization will make your child sick or is some kind of conspiracy theory. Does the vaccine hurt?…yes. Are adolescents, especially girls, more likely to pass out with this immunization?…sure. Do all immunization involve a very small likelihood of serious risk?…yes. But that’s about it. And those risks are much smaller than the risk you or your child has of being affected by HPV related disease. Our role as health care providers is to educate and advocate. If you ask any of my medical students they will tell you how they endured the “all things HPV” lecture during their time on OBGYN. My hope is that there will be more voices who advocate for HPV immunization and than any loud voice that might tell them otherwise.
So, health care providers….RECOMMEND the HPV vaccine. Telling a women she has cervical cancer, treating recurrent genital warts, seeing complication of pregnancies caused by the treatment of HPV related diseases is heart-breaking work. Trust that your patients will listen to you. Present them with the truth and advocate for their future health and the health of the people they love.
Parents, pre-adolescents, teens, and those who know or love a parent, pre-adolescent or teen: don’t assume it can’t happen to you. As Ben Franklin said “an ounce of prevention is worth a pound of cure.” I hope I have to find something to do with those 20 hours a month I spend screening and treating HPV related disease. I hope that someday we will speak of cervical cancer and other HPV related diseases like we do of polio. Ask questions, get vaccinated, tell others. If you have questions, ask a trusted health care provider. If they can’t answer them, find another health care provider who can. You never know who the 4000 lives are that would be saved.